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Abstract: In this case, a 17-year-old boy was admitted to the hospital with a convulsive seizure. The patient had a sudden onset of convulsions in the evening, with loss of consciousness, spasms of the limbs, and foaming at the mouth, which lasted for about 10 minutes or so before gradually subsiding. After completing relevant examinations, the patient was diagnosed with septic encephalitis, which is a type of bacterial encephalitis. After timely administration of medication, the headache symptoms gradually subsided and the convulsions did not recur, and he was finally discharged.
Basic information】Male, 17 years old
Type of disease】Septic encephalitis
Hospital】Jixi City People’s Hospital
Date of consultation】04/2022
【Treatment plan】Medication (Ceftriaxone sodium for injection, Haemoprim injection, Methylprednisolone sodium succinate for injection, Compound mannitol injection, Phenobarbital sodium for injection)
[Treatment period] 21 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect]: The symptoms were gradually relieved and the patient was discharged from the hospital.
I. Initial consultation
The patient was admitted to the hospital with a convulsive seizure, which occurred suddenly in the evening, with loss of consciousness, spasms of the limbs, and foaming at the mouth, and lasted for about 10 minutes before gradually relieving, and his parents sent him to our hospital immediately after the appearance of the convulsion. When we saw the patient, the symptoms of convulsions had been relieved, but there were still obvious discomfort such as headache, peripheral weakness and joint pain, etc. Based on the symptoms, we initially considered it to be an epilepsy-like disease.
Family members: The patient had no previous convulsions, but about 1 week before the convulsions occurred, he had been coughing, coughing yellow sputum, runny nose, fever and other symptoms since 1 week because of rain on the way to school, and his body temperature was up to 38.0℃, but he did not consult a doctor in time because of the tight study schedule, and only took cold medicine and antipyretic medicine on his own. In the last 2-3 days, the patient had symptoms such as poor mental status, depression, headache and vomiting. Until this evening, the patient suddenly had a convulsion at school. Hearing this, I realized that the convulsive seizure might be secondary to other diseases, and the first consideration was bacterial encephalitis, so I first examined the patient.
Physical examination: temperature: 39.0°C; dry and wet rales could be heard in both lungs. Neurological examination: cervical ankylosis, positive Creutzfeldt-Jakob sign. The patient was then given relevant ancillary tests: routine blood tests showed: leukocytes: 15.13×10^9/L; neutrophil ratio: 94.34%; neutrophils: 14.27×10^9/L; calcitoninogen: 13.89ng/mL; C-reactive protein: 186.76mg/L. Head CT showed no abnormalities, lung CT showed inflammatory changes in the lower lobe of the left lung, and EEG showed spikes. EEG showed spike waves. Combining the above tests, the patient was basically diagnosed with headache and epilepsy due to encephalitis, and was admitted to the hospital.
(Cranial CT)
II. Treatment history
After informing the family of the situation under consideration, the family was particularly nervous. I reassured the family that if encephalitis is treated actively in the early stage and the appropriate treatment is used in a timely manner, the symptoms can be gradually relieved after the disappearance of bacteria and inflammatory cells, and the family gradually relaxed their nervousness after hearing the introduction and said they would definitely cooperate with the treatment. After considering bacterial encephalitis, a lumbar puncture cerebrospinal fluid examination was also required, which showed: cerebrospinal fluid protein: 2394 mg/L; glucose: 0.03 mmol/L; cerebrospinal fluid chloride: 105.1 mmol/L; cerebrospinal fluid white blood cell count: 500 × 10^6/L; cerebrospinal fluid protein qualitative positive; lactate dehydrogenase: 295.7 U/L; cerebrospinal fluid appearance colorless and slightly gray. And the patient’s cerebrospinal fluid pressure was significantly higher during lumbar puncture.
In response to the patient’s condition, we firstly administered a broad-spectrum 3rd generation cephalosporin antibiotic with good penetrating effect on the blood-brain barrier, ceftriaxone sodium for injection, intravenously, and secondly gave the patient anti-inflammatory and antiviral treatment with haematopoietin injection, intravenously. Because the patient is currently in the acute stage of septic encephalitis, to help reduce the inflammation to brain irritation, glucocorticoid therapy was used to reduce the inflammatory response and cerebral edema, and sodium methylprednisolone succinate for injection was given intravenously. To help reduce cerebral edema and intracranial pressure, the patient was treated with dehydration and cranial pressure lowering therapy using intravenous injection of compound mannitol. Finally, the patient was given symptomatic supportive treatment. The patient was given anticonvulsant treatment using sodium phenobarbital injection intramuscularly because of inflammatory brain stimulation and increased intracranial pressure, which led to the occurrence of epileptiform symptoms.
(Lumbar puncture cerebrospinal fluid examination)
III. Treatment effect
After 21 days of systematic and adequate antibiotic treatment, as well as other symptomatic treatment and nutritional support, the patient’s symptoms improved significantly, gradually reducing the fever to normal, no more seizures, and also the mental status and headache improved significantly. During the treatment period, the patient was under great stress for fear of delaying the college entrance examination. I encouraged the patient to pay attention to rest, relax, ensure nutrition and improve the immunity of the body in order to recover better and to ensure a good body, which is also an important prerequisite for the college entrance examination. The patient followed the doctor’s advice and cooperated actively, and her symptoms gradually subsided and she was discharged from the hospital.
IV. Notes
We are glad that after a series of treatments, the patient’s condition was reversed, but an outpatient follow-up for 1 month is needed. The family was also instructed to provide adequate nutrition to the patient. The immunity of the patient will be significantly reduced when septic encephalitis occurs, and a lack of nutrients in the diet during this period will lead to a lack of immunity and is not conducive to recovery, so you can consume more foods rich in protein and vitamins. During the period of systemic inflammation, insufficient water intake is not conducive to improving the body’s immunity and fighting inflammation, and drinking more water can also reduce the occurrence of infectious shock. In addition, patients should avoid straining, pay more attention to rest, and not neglect their bodies because they are facing the college entrance examination.
V. Personal insight
Septic encephalitis is a type of bacterial encephalitis that can develop at any age. Most of the infections that occur before the onset of the disease, such as colds, pneumonia, acute gastroenteritis, and other infectious diseases that are not controlled in time, cause viruses and bacteria to invade the nervous system. In this case, the patient had obvious symptoms of cold and cough, coughing, fever, headache and other symptoms one week before the onset of the disease, and did not undergo timely treatment, resulting in complications such as convulsions caused by bacterial invasion of the brain.
The prognosis of encephalitis is closely related to the type of pathogenic bacteria, the condition of the body and the early application of effective antibiotic treatment. The most effective way to improve the prognosis.